Provider Demographics
NPI:1376049742
Name:KRUCZEK, SARA ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:KRUCZEK
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3020 CHILDRENS WAY # MC5159
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY # MC5159
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-1700
Practice Address - Fax:858-966-8535
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2021-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA189752080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics