Provider Demographics
NPI:1689883654
Name:INTERNATIONAL MEDICAL ALLIANCE
Entity Type:Organization
Organization Name:INTERNATIONAL MEDICAL ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNLEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-967-9300
Mailing Address - Street 1:PO BOX 15546
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95852-0546
Mailing Address - Country:US
Mailing Address - Phone:916-967-9300
Mailing Address - Fax:916-967-9301
Practice Address - Street 1:8653 DEERING BAY DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-1757
Practice Address - Country:US
Practice Address - Phone:916-967-9300
Practice Address - Fax:916-967-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61359208100000X
NV11845261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty