MEDICARE: SEAN MARIANO LOPEZ WOOD FNP-BC

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	363LF0000X	Family Nurse Practitioner	95039725	CA

General Provider Information

NPI Number	:	1295666311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN MARIANO LOPEZ WOOD FNP-BC

Provider Business Mailing Address
First Line	:	21 PROMONTORY
Second Line	:
City	:	TRABUCO CANYON
State	:	CA
Zip	:	92679-3811
Country	:	US
Telephone Number	:	949-350-3935
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 MARK LN
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-6718
Country	:	US
Telephone Number	:	949-350-3935
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	06/01/2026

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