Provider Demographics
NPI:1447392113
Name:BROMBERG, ALISA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:ANN
Last Name:BROMBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:970 MONUMENT ST STE 220
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3898
Mailing Address - Country:US
Mailing Address - Phone:310-454-2296
Mailing Address - Fax:310-454-2295
Practice Address - Street 1:881 ALMA REAL DR STE 316
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-5061
Practice Address - Country:US
Practice Address - Phone:310-454-2296
Practice Address - Fax:310-454-2295
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG81092208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics