Healthcare Provider Details

I. General information

NPI: 1346176062
Provider Name (Legal Business Name): VICTORIA KELLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA MIFUNE RN

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 GRANT RD
MOUNTAIN VIEW CA
94040-4302
US

IV. Provider business mailing address

8360 KYLER RD
ELK GROVE CA
95757-5060
US

V. Phone/Fax

Practice location:
  • Phone: 650-940-7000
  • Fax:
Mailing address:
  • Phone: 669-288-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95311579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: