Healthcare Provider Details

I. General information

NPI: 1588271761
Provider Name (Legal Business Name): LUIS ENRIQUE LARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41870 MCALBY CT
MURRIETA CA
92562-7036
US

IV. Provider business mailing address

262 W 1ST ST
PERRIS CA
92570-2001
US

V. Phone/Fax

Practice location:
  • Phone: 951-304-1592
  • Fax:
Mailing address:
  • Phone: 951-210-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: