Provider Demographics
NPI:1245222520
Name:TRUST, MICHAEL CLAUDE II (RD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CLAUDE
Last Name:TRUST
Suffix:II
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23627 SUNSET PEAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7543
Mailing Address - Country:US
Mailing Address - Phone:912-492-6453
Mailing Address - Fax:
Practice Address - Street 1:1919 LOCKHILL SELMA RD 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1506
Practice Address - Country:US
Practice Address - Phone:210-843-2995
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06414133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered