Provider Demographics
NPI:1275506784
Name:BIOACTIVE THERAPEUTICS
Entity Type:Organization
Organization Name:BIOACTIVE THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:COTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:916-288-0578
Mailing Address - Street 1:3499 BROOKSIDE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1784
Mailing Address - Country:US
Mailing Address - Phone:916-288-0578
Mailing Address - Fax:
Practice Address - Street 1:3499 BROOKSIDE RD
Practice Address - Street 2:SUITE F
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-1784
Practice Address - Country:US
Practice Address - Phone:916-288-0578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management