Healthcare Provider Details

I. General information

NPI: 1497946917
Provider Name (Legal Business Name): REBECCA JEAN BABINSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LOUISIANA BLVD NE STE 410
ALBUQUERQUE NM
87110-5412
US

IV. Provider business mailing address

2100 LOUISIANA BLVD NE STE 410
ALBUQUERQUE NM
87110-5412
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-4300
  • Fax: 505-724-4384
Mailing address:
  • Phone: 505-724-4300
  • Fax: 505-724-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2004-0003
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: