Organization
REBEL DISTRIBUTION CORP
Active
Other names
PHYSICIAN PARTNER
Organization subpart
No
Provider details
NPI number
Authorized official
DESTRY SETSER (EXEC VP)
(805) 375-0800
Entity
Organization
Contact information
Practice address
3607 OLD CONEJO RD, THOUSAND OAKS, CA 91320-2123
(805) 375-0800
(805) 375-0885
Mailing address
3607 OLD CONEJO RD, THOUSAND OAKS, CA 91320-2123
(805) 375-0800
(805) 375-0885
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
WLS3004
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5623029
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/10/2006
Last updated
10/15/2009
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