Provider Demographics
NPI:1386418341
Name:SANDOVAL OSUNA, DORINA IVETTE (LCSW)
Entity type:Individual
Prefix:
First Name:DORINA
Middle Name:IVETTE
Last Name:SANDOVAL OSUNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DORINA
Other - Middle Name:IVETTE
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:960 N EMERSON ST APT 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2995
Mailing Address - Country:US
Mailing Address - Phone:858-531-3999
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:858-531-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099293221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical