# WALLACE HOME MEDICAL SUPPLIES

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

## Provider details

- **NPI number:** 1790947828
- **Authorized official:** MR. TRAGO WALLACE ATS (PRESIDENT)
- **Authorized official phone:** (805) 238-3935

## Contact information

- **Practice address:** 549 10TH ST, PASO ROBLES, CA 93446-2510
- **Practice address phone:** (805) 238-3935
- **Mailing address:** 549 10TH ST, PASO ROBLES, CA 93446-2510
- **Mailing address phone:** (805) 238-3935

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 06/30/2008
- **Last updated:** 06/17/2013