Healthcare Provider Details

I. General information

NPI: 1982409579
Provider Name (Legal Business Name): FM WOUNDCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2254 250TH ST
LOMITA CA
90717-2138
US

IV. Provider business mailing address

2254 250TH ST
LOMITA CA
90717-2138
US

V. Phone/Fax

Practice location:
  • Phone: 310-955-8213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FARAH BANGASH
Title or Position: OWNER
Credential:
Phone: 310-955-8213