Provider Demographics
NPI:1902525124
Name:SHAKA SURF CLUB
Entity Type:Organization
Organization Name:SHAKA SURF CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-584-6290
Mailing Address - Street 1:26565 AGOURA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1990
Mailing Address - Country:US
Mailing Address - Phone:818-584-6290
Mailing Address - Fax:888-222-1042
Practice Address - Street 1:26565 AGOURA RD STE 200
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1990
Practice Address - Country:US
Practice Address - Phone:818-584-6290
Practice Address - Fax:888-222-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty