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General NPI Number Information
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NPI Number | 1932884566
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Entity Type | Organization
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Legal Business Name | MAN ALIVE HORMONE AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 9625 SPENCER HWY # A
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City | LA PORTE
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State | TX
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Zip | 77571-3882
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Country | US
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Telephone | 832-588-6437
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 HOLLOW MIST LN
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City | PEARLAND
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State | TX
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Zip | 77581-5689
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Country | US
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Telephone | 832-588-6437
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KYLE STANILLA
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Credential |
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Telephone | 832-588-6437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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