Healthcare Provider Details

I. General information

NPI: 1679219604
Provider Name (Legal Business Name): MARAI ROQUE SOLARES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S MACDILL AVE STE 300
TAMPA FL
33609-3589
US

IV. Provider business mailing address

110 S MACDILL AVE STE 300
TAMPA FL
33609-3589
US

V. Phone/Fax

Practice location:
  • Phone: 813-428-9930
  • Fax: 813-738-0442
Mailing address:
  • Phone: 813-428-9930
  • Fax: 813-738-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME171627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: