Individual
BRENDA J. LILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4650 W SWEETWATER AVE, GLENDALE, AZ 85304-1505
(602) 347-2600
(602) 347-2709
Mailing address
4650 W SWEETWATER AVE, GLENDALE, AZ 85304-1505
(602) 347-2600
(602) 347-2709
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
2708188
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
558794
—
AZ
Enumeration date
09/17/2008
Last updated
09/17/2008
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