MEDICARE: MS. FATIMA YAZMIN LOMELI PA-C

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	363A00000X	Physician Assistant	TEMPORARY	TX
2	363A00000X	Physician Assistant	PA16782	TX

General Provider Information

NPI Number	:	1144925694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FATIMA YAZMIN LOMELI PA-C

Provider Business Mailing Address
First Line	:	941 SHERRY LN
Second Line	:
City	:	SAGINAW
State	:	TX
Zip	:	76179-0979
Country	:	US
Telephone Number	:	682-365-1806
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 9TH AVE STE 401
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3918
Country	:	US
Telephone Number	:	817-332-0786
Fax Number	:

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

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/28/2023

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