Healthcare Provider Details

I. General information

NPI: 1023953197
Provider Name (Legal Business Name): OWEN J BRATCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 CALLE CUERVO NW APT 1016
ALBUQUERQUE NM
87114-9239
US

IV. Provider business mailing address

10511 GOLF COURSE RD NW STE 103
ALBUQUERQUE NM
87114-5917
US

V. Phone/Fax

Practice location:
  • Phone: 505-627-5128
  • Fax:
Mailing address:
  • Phone: 505-627-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: