=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033005707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUTURE MOVEMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2025
-----------------------------------------------------
Last Update Date | 06/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 EL CAMINO REAL
-----------------------------------------------------
City | MILLBRAE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94030-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-889-0545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 376 OLIVE ST
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94513-6339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-889-0545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MELISSA RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-889-0545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------