# WALLACE HOME MEDICAL SUPPLIES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215096466
- **Authorized official:** MATTHEW TRAGO WALLACE (OWNER)
- **Authorized official phone:** (805) 238-3935

## Contact information

- **Practice address:** 1414 PARK ST, PASO ROBLES, CA 93446-2160
- **Practice address phone:** (805) 238-3935
- **Practice address fax:** (805) 238-3974
- **Mailing address:** 1414 PARK ST, PASO ROBLES, CA 93446-2160
- **Mailing address phone:** (805) 238-3935
- **Mailing address fax:** (805) 238-3974

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 103383 | CA | Yes |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | 18268 | CA | — |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 04/20/2008