Provider Demographics
NPI:1356396287
Name:MONTANO, JOLENE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:R
Last Name:MONTANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:
Practice Address - Street 1:5320 S RAINBOW BLVD STE 182
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1896
Practice Address - Country:US
Practice Address - Phone:702-255-3547
Practice Address - Fax:702-212-4993
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME121001207V00000X
GA042897207V00000X
NV22540207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV22540OtherSTATE LIRCENSE
GA000732817CMedicaid
GA16BDTKVMedicare ID - Type Unspecified