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General NPI Number Information
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NPI Number | 1790947828
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Entity Type | Organization
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Legal Business Name | WALLACE HOME MEDICAL SUPPLIES
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 549 10TH ST
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City | PASO ROBLES
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State | CA
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Zip | 93446-2510
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Country | US
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Telephone | 805-238-3935
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Fax |
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Provider Business Mailing Address
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Address Line | 549 10TH ST
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City | PASO ROBLES
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State | CA
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Zip | 93446-2510
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Country | US
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Telephone | 805-238-3935
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TRAGO WALLACE
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Credential | ATS
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Telephone | 805-238-3935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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