Healthcare Provider Details

I. General information

NPI: 1497629356
Provider Name (Legal Business Name): VELLURA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5483 N BLACK SAND AVE
MERIDIAN ID
83646-5662
US

IV. Provider business mailing address

6700 N LINDER RD STE 156A
MERIDIAN ID
83646-6607
US

V. Phone/Fax

Practice location:
  • Phone: 509-251-8920
  • Fax: 208-264-9569
Mailing address:
  • Phone: 509-251-8920
  • Fax: 208-264-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR RENAE GARCIA
Title or Position: OWNER/ NURSE PRACTITIONER
Credential: APRN
Phone: 509-251-8920