Healthcare Provider Details

I. General information

NPI: 1295666311
Provider Name (Legal Business Name): SEAN MARIANO LOPEZ WOOD FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MARK LN
COSTA MESA CA
92626-6718
US

IV. Provider business mailing address

21 PROMONTORY
TRABUCO CANYON CA
92679-3811
US

V. Phone/Fax

Practice location:
  • Phone: 949-350-3935
  • Fax:
Mailing address:
  • Phone: 949-350-3935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: