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General NPI Number Information
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NPI Number | 1689883654
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL MEDICAL ALLIANCE
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 8653 DEERING BAY DR
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City | LAS VEGAS
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State | NV
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Zip | 89131-1757
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Country | US
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Telephone | 916-967-9300
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Fax | 916-967-9301
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Provider Business Mailing Address
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Address Line | PO BOX 15546
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City | SACRAMENTO
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State | CA
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Zip | 95852-0546
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Country | US
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Telephone | 916-967-9300
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Fax | 916-967-9301
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DANIEL B DUNLEVY
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Credential | MD
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Telephone | 916-967-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | G61359
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 11845
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License Number State | NV
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