Provider Demographics
NPI:1295301117
Name:LARA, RUBEN VINCENT II
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:VINCENT
Last Name:LARA
Suffix:II
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 1:10809 WESTWOOD LOOP APT 1516
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5715
Mailing Address - Country:US
Mailing Address - Phone:210-639-1883
Mailing Address - Fax:
Practice Address - Street 1:10809 WESTWOOD LOOP APT 1516
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5715
Practice Address - Country:US
Practice Address - Phone:210-639-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician