Healthcare Provider Details

I. General information

NPI: 1336870484
Provider Name (Legal Business Name): WOMEN'S HEALTH 360, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUPERIOR AVE STE 305
NEWPORT BEACH CA
92663-3660
US

IV. Provider business mailing address

500 SUPERIOR AVE STE 305
NEWPORT BEACH CA
92663-3660
US

V. Phone/Fax

Practice location:
  • Phone: 949-644-2722
  • Fax: 949-650-3135
Mailing address:
  • Phone: 949-644-2722
  • Fax: 949-650-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLIE ANDREA WILLIAMS
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 949-644-2722