Healthcare Provider Details

I. General information

NPI: 1114864063
Provider Name (Legal Business Name): ADA FAVOUUR EKWEREKWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S OAKHURST DR APT 3E
BEVERLY HILLS CA
90212-3524
US

IV. Provider business mailing address

16500 VENTURA BLVD STE 414
ENCINO CA
91436-5050
US

V. Phone/Fax

Practice location:
  • Phone: 916-620-2739
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: