Basic Information
| Provider Information | |||||||||
| NPI: | 1972020170 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FASHOLA | ||||||||
| FirstName: | ADEBOWALE | ||||||||
| MiddleName: | OLADEJO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14660 OXNARD ST. | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014836 | ||||||||
| FaxNumber: | 8183760044 | ||||||||
| Practice Location | |||||||||
| Address1: | 14660 OXNARD ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914113119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189044836 | ||||||||
| FaxNumber: | 8183770044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2017 | ||||||||
| LastUpdateDate: | 10/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 78268 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.