Healthcare Provider Details

I. General information

NPI: 1619816535
Provider Name (Legal Business Name): WE ROCK THE SPECTRUM KID'S GYM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 CREBS AVE
TARZANA CA
91356-3330
US

IV. Provider business mailing address

5520 CREBS AVE
TARZANA CA
91356-3330
US

V. Phone/Fax

Practice location:
  • Phone: 818-585-5687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DINA KIMMEL
Title or Position: OWNER & PROGRAM DIRECTOR
Credential:
Phone: 818-585-5687