Healthcare Provider Details

I. General information

NPI: 1184553356
Provider Name (Legal Business Name): ILLURA HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10328 RESEDA BLVD
NORTHRIDGE CA
91326-3433
US

IV. Provider business mailing address

10328 RESEDA BLVD
NORTHRIDGE CA
91326-3433
US

V. Phone/Fax

Practice location:
  • Phone: 818-689-2851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LAYSON
Title or Position: PRACTICE OWNER
Credential:
Phone: 818-689-2851