Rebel Distribution Corp

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

WLS3004 Issued in CA

Legal business name

REBEL DISTRIBUTION CORP

Practice address

3607 Old Conejo Rd
Thousand Oaks, CA 91320-2123

Phone

(805) 375-0800

Fax

(805) 375-0885

NPI assigned

Aug 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Destry Setser

Title

Exec VP

Phone

(805) 375-0800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PHYSICIAN PARTNER Doing business as

Tax ID family

Physician Partner2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Rebel Distributors

  • Non-Pharmacy Dispensing Site
  • Thousand Oaks, CA
  • NPI 1366657488
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255564800000",
    "number": "1023029535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3607 OLD CONEJO RD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913202123",
            "telephone_number": "805-375-0800",
            "fax_number": "805-375-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3607 OLD CONEJO RD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913202123",
            "telephone_number": "805-375-0800",
            "fax_number": "805-375-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBEL DISTRIBUTION CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2009-10-15",
        "status": "A",
        "authorized_official_last_name": "SETSER",
        "authorized_official_first_name": "DESTRY",
        "authorized_official_title_or_position": "EXEC VP",
        "authorized_official_telephone_number": "805-375-0800"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "WLS3004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5623029",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICIAN PARTNER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pegah Raven, OD
• Sheila Ray, BA
• Raymond L Lam MD Inc
• Ahsan Syed Raza, D.D.S.
• Timothy Jerad Rearick, MD
• Rebel Distributors
• Jacob Reck, DO
• Recooperation Physical Therapy Inc
• Cassidy Rose Rector, LMFT 158242
• Sara Pollman Rector, MFT

• Durable Medical Equipment & Medical Supplies in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.