Rebel Distributors

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

WLS3004 Issued in CA

Legal business name

REBEL DISTRIBUTORS

Practice address

3607 Old Conejo Rd
Thousand Oaks, CA 91320-2123

Phone

(805) 214-0900

Fax

(805) 214-0950

NPI assigned

May 11, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Destry Setser

Title

Ceo/Owner

Phone

(877) 732-3579

Specialties & licenses 2

Addresses

Other names 1

• Physician Partner/Pharmacy 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 Distribution Corp

  • Durable Medical Equipment & Medical Supplies
  • Thousand Oaks, CA
  • NPI 1023029535
  NPD tax ID

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233619200000",
    "number": "1366657488",
    "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": "805-214-0900",
            "fax_number": "805-214-0950"
        },
        {
            "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": "805-214-0900",
            "fax_number": "805-214-0950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBEL DISTRIBUTORS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2009-02-03",
        "status": "A",
        "authorized_official_last_name": "SETSER",
        "authorized_official_first_name": "DESTRY",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "877-732-3579",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "WLS3004",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "WLS3004",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physician Partner/Pharmacy Partner",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• Non-Pharmacy Dispensing Site in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.