Healthcare Provider Details

I. General information

NPI: 1891776274
Provider Name (Legal Business Name): BABAK MIRIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BABAK MIRIN M.D.

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COMANCHE RD NE STE E6
ALBUQUERQUE NM
87107-4546
US

IV. Provider business mailing address

PO BOX 8244
ROSWELL NM
88202-8244
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-4500
  • Fax: 505-881-5158
Mailing address:
  • Phone: 575-624-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2002-0076
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number20020076
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number20020076
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2002-0076
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: