Provider Demographics
NPI:1235987710
Name:SOLANO MATUTE, ROGER ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:ALBERTO
Last Name:SOLANO MATUTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 HULL AVE. APT 2A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-579-5030
Mailing Address - Fax:
Practice Address - Street 1:234 EAST 149TH STREET
Practice Address - Street 2:ROOM 4-20
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2025-01-28
Deactivation Date:2025-01-10
Deactivation Code:
Reactivation Date:2025-01-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program