Healthcare Provider Details

I. General information

NPI: 1164779203
Provider Name (Legal Business Name): MR. RUBEN LUIS LARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 10TH AVE
TOPEKA KS
66604-1301
US

IV. Provider business mailing address

325 SW FRAZIER AVE
TOPEKA KS
66606-1963
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-6000
  • Fax:
Mailing address:
  • Phone: 785-232-5005
  • Fax: 785-232-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06423
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: