Healthcare Provider Details

I. General information

NPI: 1902699242
Provider Name (Legal Business Name): ALYSSA BRENDA-SUE FLORES AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA BRENDA-SUE ZAIDERVELD

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 11/09/2025
Certification Date: 11/09/2025
Deactivation Date: 06/09/2025
Reactivation Date: 11/05/2025

III. Provider practice location address

1890 W MAIN ST SUITE 110
BARSTOW CA
92311
US

IV. Provider business mailing address

1890 W MAIN ST STE 110
BARSTOW CA
92311-3726
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-1422
  • Fax:
Mailing address:
  • Phone: 760-256-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95154380
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95036522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: