Healthcare Provider Details

I. General information

NPI: 1376341024
Provider Name (Legal Business Name): XAVIER ZAIRE RIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 GRASSELLI ST
EAST CHICAGO IN
46312-3503
US

IV. Provider business mailing address

3809 ALDER ST FL 1
EAST CHICAGO IN
46312-2363
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5201
  • Fax:
Mailing address:
  • Phone: 219-269-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-409137
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: