Provider Demographics
NPI:1619080314
Name:JAO, MONINA MARTINEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MONINA
Middle Name:MARTINEZ
Last Name:JAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 TONI LN
Mailing Address - Street 2:
Mailing Address - City:ST. CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950
Mailing Address - Country:US
Mailing Address - Phone:740-695-2215
Mailing Address - Fax:740-633-6756
Practice Address - Street 1:92 N. 4TH ST
Practice Address - Street 2:STE. 29
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935
Practice Address - Country:US
Practice Address - Phone:740-633-6741
Practice Address - Fax:740-633-6756
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2025810Medicaid
OHG59625Medicare UPIN
OH0834116Medicare PIN