Provider Demographics
NPI:1932884566
Name:MAN ALIVE HORMONE AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:MAN ALIVE HORMONE AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-588-6437
Mailing Address - Street 1:1919 HOLLOW MIST LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5689
Mailing Address - Country:US
Mailing Address - Phone:832-588-6437
Mailing Address - Fax:
Practice Address - Street 1:9625 SPENCER HWY # A
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-3882
Practice Address - Country:US
Practice Address - Phone:832-588-6437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty