MEDICARE: ILLURA HEALTH & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1184553356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLURA HEALTH & WELLNESS

Provider Business Mailing Address
First Line	:	10328 RESEDA BLVD
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-3433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10328 RESEDA BLVD
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-3433
Country	:	US
Telephone Number	:	818-689-2851
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	MICHAEL LAYSON
Credential	:
Telephone Number	:	818-689-2851

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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Directions to “ILLURA HEALTH & WELLNESS ” Practice Location

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