Healthcare Provider Details

I. General information

NPI: 1629010277
Provider Name (Legal Business Name): REBECCA GIRARDET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 SILVER AVE SW FL 2
ALBUQUERQUE NM
87102-3123
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6849
  • Fax: 505-272-6844
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ8249
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberMD2021--0261
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: