Healthcare Provider Details

I. General information

NPI: 1124413836
Provider Name (Legal Business Name): SARA ELIZABETH GRZYWA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 06/06/2022
Certification Date: 06/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13525 CENTERBROOK STE 104
UNIVERSAL CITY TX
78148-2734
US

IV. Provider business mailing address

13525 CENTERBROOK STE 104
UNIVERSAL CITY TX
78148-2734
US

V. Phone/Fax

Practice location:
  • Phone: 210-375-3318
  • Fax: 210-257-6931
Mailing address:
  • Phone: 210-375-3318
  • Fax: 210-257-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number3043
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number3043
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number3043
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number3043
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: