# MAN ALIVE HORMONE AND WELLNESS CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932884566
- **Authorized official:** KYLE STANILLA (NURSE PRACTITIONER)
- **Authorized official phone:** (832) 588-6437

## Contact information

- **Practice address:** 9625 SPENCER HWY \# A, LA PORTE, TX 77571-3882
- **Practice address phone:** (832) 588-6437
- **Mailing address:** 1919 HOLLOW MIST LN, PEARLAND, TX 77581-5689
- **Mailing address phone:** (832) 588-6437

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/20/2023
- **Last updated:** 06/22/2023