Provider Demographics
NPI:1326925736
Name:SANDOVAL-CLOR, MARISSA LYSETTE
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYSETTE
Last Name:SANDOVAL-CLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:LYSETTE TEAMAR
Other - Last Name:SANDOVAL CRUZ-CLOR SHARKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4035 WESTMEADOW DR APT 2222
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-6063
Mailing Address - Country:US
Mailing Address - Phone:719-661-6285
Mailing Address - Fax:
Practice Address - Street 1:4035 WESTMEADOW DR APT 2222
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-6063
Practice Address - Country:US
Practice Address - Phone:719-661-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician