Organization
MAN ALIVE HORMONE AND WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE STANILLA (NURSE PRACTITIONER)
(832) 588-6437
Entity
Organization
Contact information
Practice address
9625 SPENCER HWY # A, LA PORTE, TX 77571-3882
(832) 588-6437
Mailing address
1919 HOLLOW MIST LN, PEARLAND, TX 77581-5689
(832) 588-6437
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Enumeration date
06/20/2023
Last updated
06/22/2023
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