Provider Demographics
NPI:1629010277
Name:GIRARDET, REBECCA (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GIRARDET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2719
Mailing Address - Country:US
Mailing Address - Phone:713-553-5025
Mailing Address - Fax:
Practice Address - Street 1:625 SILVER AVE SW FL 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3123
Practice Address - Country:US
Practice Address - Phone:505-272-6849
Practice Address - Fax:505-272-6844
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8249208000000X
NMMD2021--02612080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN138453910OtherCSHCN
TX81700KOtherBCBS
TX138453912Medicaid
TX138453912Medicaid
TN138453910OtherCSHCN
TXG15825Medicare UPIN