Healthcare Provider Details

I. General information

NPI: 1184540619
Provider Name (Legal Business Name): LES MUMININ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5479 IMPERIAL AVE APT 4
SAN DIEGO CA
92114-3926
US

IV. Provider business mailing address

PO BOX 741083
SAN DIEGO CA
92174-1083
US

V. Phone/Fax

Practice location:
  • Phone: 619-765-8094
  • Fax: 619-765-8094
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KNYLARIE JAINE MATHIS
Title or Position: MANAGING MEMBER
Credential: CEO
Phone: 619-765-8094