Provider Demographics
NPI:1215921663
Name:TATAY, RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:TATAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 BRIDLE LN
Mailing Address - Street 2:2222 SOUTH 16TH ST, SUITE 330
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3438
Mailing Address - Country:US
Mailing Address - Phone:402-730-6061
Mailing Address - Fax:402-474-1611
Practice Address - Street 1:2222 S 16TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3796
Practice Address - Country:US
Practice Address - Phone:402-474-1511
Practice Address - Fax:402-474-1611
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE159562084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEAT8023335OtherDDA
NE100250661-00Medicaid
NE263470Medicare ID - Type Unspecified
NE100250661-00Medicaid