Healthcare Provider Details

I. General information

NPI: 1437358397
Provider Name (Legal Business Name): KARY MICHELLE BOUET-RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S3-15 CALLE 3
SAN JUAN PR
00926-6047
US

IV. Provider business mailing address

3 STREET S 315 VILLAS DE PARANA
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 178-777-5555
  • Fax:
Mailing address:
  • Phone: 787-753-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number17581
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11413
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: