Provider Demographics
NPI:1437358397
Name:BOUET-RIVERA, KARY MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:KARY
Middle Name:MICHELLE
Last Name:BOUET-RIVERA
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 1:3 STREET S 315
Mailing Address - Street 2:VILLAS DE PARANA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-753-6390
Mailing Address - Fax:
Practice Address - Street 1:S3-15 CALLE 3
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6047
Practice Address - Country:US
Practice Address - Phone:178-777-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11413208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics