MEDICARE: DR. ALISA ANN BROMBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G81092	CA

General Provider Information

NPI Number	:	1447392113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISA ANN BROMBERG M.D.

Provider Business Mailing Address
First Line	:	970 MONUMENT ST STE 220
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-3898
Country	:	US
Telephone Number	:	310-454-2296
Fax Number	:	310-454-2295

Provider Business Practice Location Address
First Line	:	881 ALMA REAL DR STE 316
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-5061
Country	:	US
Telephone Number	:	310-454-2296
Fax Number	:	310-454-2295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	01/09/2024

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