Healthcare Provider Details

I. General information

NPI: 1073311460
Provider Name (Legal Business Name): GEOFFEY L KAMEN MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 GROVE ST # B
SAN LUIS OBISPO CA
93401-2914
US

IV. Provider business mailing address

793 E FOOTHILL BLVD STE A117
SAN LUIS OBISPO CA
93405-1615
US

V. Phone/Fax

Practice location:
  • Phone: 805-596-1565
  • Fax: 833-428-4062
Mailing address:
  • Phone: 805-550-8880
  • Fax: 833-428-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GEOFFREY L KAMEN
Title or Position: DIRECTOR
Credential: MD
Phone: 805-596-1565