Healthcare Provider Details

I. General information

NPI: 1710822150
Provider Name (Legal Business Name): TIERRA LILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7875 MONTGOMERY RD SPC 42
CINCINNATI OH
45236-4331
US

IV. Provider business mailing address

1873 LOSANTIVILLE AVE APT 1
CINCINNATI OH
45237-3906
US

V. Phone/Fax

Practice location:
  • Phone: 513-283-6042
  • Fax:
Mailing address:
  • Phone: 513-283-6042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.007549
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: