Healthcare Provider Details

I. General information

NPI: 1194158543
Provider Name (Legal Business Name): LIYA BROMBERG M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 QUIMBY RD
SAN JOSE CA
95148-3122
US

IV. Provider business mailing address

15339 SATICOY ST BLDG 300
VAN NUYS CA
91406-3345
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-7063
  • Fax:
Mailing address:
  • Phone: 818-267-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: