Provider Demographics
NPI:1225347693
Name:FRIAS, RUBEN LAVARIAS
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:LAVARIAS
Last Name:FRIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2436 E 8TH ST
Mailing Address - Street 2:APT. 61
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2955
Mailing Address - Country:US
Mailing Address - Phone:619-479-8418
Mailing Address - Fax:
Practice Address - Street 1:510 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5324
Practice Address - Country:US
Practice Address - Phone:619-440-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse