Healthcare Provider Details

I. General information

NPI: 1972020170
Provider Name (Legal Business Name): ADEBOWALE OLADEJO FASHOLA MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16650 SHERMAN WAY
VAN NUYS CA
91406-3782
US

IV. Provider business mailing address

16650 SHERMAN WAY
VAN NUYS CA
91406-3782
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4836
  • Fax: 818-377-0044
Mailing address:
  • Phone: 818-901-4836
  • Fax: 818-376-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: