Organization
WALLACE HOME MEDICAL SUPPLIES
Active
Parent organization
WALLACE HOME MEDICAL SUPPLIES
Other names
Wallace Home Medical Supplies
Organization subpart
Yes
Provider details
NPI number
Legal business name
WALLACE HOME MEDICAL SUPPLIES
Authorized official
MATTHEW TRAGO WALLACE (PRESIDENT)
(805) 238-3935
Entity
Organization
Contact information
Practice address
12310 LOS OSOS VALLEY RD, SAN LUIS OBISPO, CA 93405-7220
(805) 439-4007
Mailing address
549 10TH ST, PASO ROBLES, CA 93446-2510
(805) 238-3935
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/20/2014
Last updated
08/06/2015
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