Healthcare Provider Details

I. General information

NPI: 1003151036
Provider Name (Legal Business Name): PLAZA WEST PSYCHIATRISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 12/04/2012
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSE GARY NADALA
Title or Position: OWNER
Credential: M.D
Phone: 402-474-1511