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Organization
WALLACE HOME MEDICAL SUPPLIES
Active
Organization
WALLACE HOME MEDICAL SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW TRAGO WALLACE (OWNER)
(805) 238-3935
Entity
Organization
Contact information
Practice address
1414 PARK ST, PASO ROBLES, CA 93446-2160
(805) 238-3935
(805) 238-3974
Mailing address
1414 PARK ST, PASO ROBLES, CA 93446-2160
(805) 238-3935
(805) 238-3974
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
103383
CA
332BX2000X
Oxygen Equipment & Supplies (DME)
18268
CA
Other
Enumeration date
12/06/2006
Last updated
04/20/2008
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