Healthcare Provider Details

I. General information

NPI: 1215921663
Provider Name (Legal Business Name): RAFAEL TATAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST SUITE 330
LINCOLN NE
68502-3796
US

IV. Provider business mailing address

5001 BRIDLE LN 2222 SOUTH 16TH ST, SUITE 330
LINCOLN NE
68516-3438
US

V. Phone/Fax

Practice location:
  • Phone: 402-474-1511
  • Fax: 402-474-1611
Mailing address:
  • Phone: 402-730-6061
  • Fax: 402-474-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15956
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number15956
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: