MEDICARE: KEEFE DE LA FUENTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	95450546	CA

General Provider Information

NPI Number	:	1265377170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEEFE DE LA FUENTE

Provider Business Mailing Address
First Line	:	3523 CLINTON AVE STE 100
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-6408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 SOQUEL AVE STE 150
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-1402
Country	:	US
Telephone Number	:	408-210-4832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ KEEFE DE LA FUENTE ” Practice Location

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