Healthcare Provider Details

I. General information

NPI: 1104720705
Provider Name (Legal Business Name): LUIS ALCANTARA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W WHITESTONE BLVD STE 100
CEDAR PARK TX
78613-2271
US

IV. Provider business mailing address

500 W WHITESTONE BLVD STE 100
CEDAR PARK TX
78613-2271
US

V. Phone/Fax

Practice location:
  • Phone: 512-872-6868
  • Fax:
Mailing address:
  • Phone: 512-872-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1117237
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: