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General NPI Number Information
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NPI Number | 1447392113
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Entity Type | Individual
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Provider Name | ALISA ANN BROMBERG M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 881 ALMA REAL DR STE 316
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-5061
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Country | US
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Telephone | 310-454-2296
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Fax | 310-454-2295
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Provider Business Mailing Address
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Address Line | 970 MONUMENT ST STE 220
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-3898
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Country | US
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Telephone | 310-454-2296
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Fax | 310-454-2295
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G81092
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License Number State | CA
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