Healthcare Provider Details

I. General information

NPI: 1942811617
Provider Name (Legal Business Name): ALYSSA NICOLE FLANDERS OGDEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27882 FORBES RD STE 201
LAGUNA NIGUEL CA
92677-1267
US

IV. Provider business mailing address

21756 LAKE VISTA DR
LAKE FOREST CA
92630-2416
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-9264
  • Fax:
Mailing address:
  • Phone: 818-322-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number57832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: