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General NPI Number Information
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NPI Number | 1194615591
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Entity Type | Individual
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Provider Name | LUIS PEDRO DECKER JR. FNP
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Gender | Male
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 6416 POLARIS DR STE 1B
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City | LAREDO
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State | TX
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Zip | 78041-2089
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Country | US
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Telephone | 956-568-5140
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Fax |
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Provider Business Mailing Address
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Address Line | 163 LAKE CARNEGIE CT
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City | LAREDO
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State | TX
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Zip | 78041-2062
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Country | US
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Telephone | 956-285-8939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1060897
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License Number State | TX
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