Provider Demographics
NPI:1902699242
Name:FLORES, ALYSSA BRENDA-SUE (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BRENDA-SUE
Last Name:FLORES
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:BRENDA-SUE
Other - Last Name:ZAIDERVELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1890 W MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3726
Mailing Address - Country:US
Mailing Address - Phone:760-256-1422
Mailing Address - Fax:
Practice Address - Street 1:1890 W MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311
Practice Address - Country:US
Practice Address - Phone:760-256-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-11-09
Deactivation Date:2025-06-09
Deactivation Code:
Reactivation Date:2025-11-05
Provider Licenses
StateLicense IDTaxonomies
CA95154380163WE0003X
CA95036522363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Multi-Specialty