MEDICARE: JOHAN-R LOMELI GONZALEZ PA

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	PA59776	CA

General Provider Information

NPI Number	:	1184202426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHAN-R LOMELI GONZALEZ PA

Provider Business Mailing Address
First Line	:	525 DOYLE PARK DR STE 102
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4562
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 DOYLE PARK DR STE 102
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4562
Country	:	US
Telephone Number	:	707-387-3922
Fax Number	:

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

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	10/24/2025

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Directions to “ JOHAN-R LOMELI GONZALEZ PA” Practice Location

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