Healthcare Provider Details

I. General information

NPI: 1720911530
Provider Name (Legal Business Name): FM WOUNDCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 PARK OF COMMERCE BLVD
BOCA RATON FL
33487-8247
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: 310-955-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

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