Healthcare Provider Details

I. General information

NPI: 1538041264
Provider Name (Legal Business Name): EDZEL JOHN TRONO LOPEZ DNP, RN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18255 BROOKHURST ST STE 100
FOUNTAIN VALLEY CA
92708-6771
US

IV. Provider business mailing address

18255 BROOKHURST ST STE 100
FOUNTAIN VALLEY CA
92708-6771
US

V. Phone/Fax

Practice location:
  • Phone: 714-963-7240
  • Fax:
Mailing address:
  • Phone: 714-963-7240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95173504
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95035946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: