Provider Demographics
NPI:1477717221
Name:GUST, THERESA (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:GUST
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15335 PARK ROW
Mailing Address - Street 2:APT 3403
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2891
Mailing Address - Country:US
Mailing Address - Phone:281-398-1819
Mailing Address - Fax:
Practice Address - Street 1:15335 PARK ROW
Practice Address - Street 2:APT 3403
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2891
Practice Address - Country:US
Practice Address - Phone:281-398-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80189133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal