Provider Demographics
NPI:1982375390
Name:LILES, VERONICA GAIL
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:GAIL
Last Name:LILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 S 157TH ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-2029
Mailing Address - Country:US
Mailing Address - Phone:602-405-5502
Mailing Address - Fax:
Practice Address - Street 1:3509 S 157TH ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2029
Practice Address - Country:US
Practice Address - Phone:602-405-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician