Healthcare Provider Details

I. General information

NPI: 1215015953
Provider Name (Legal Business Name): GEOFFREY L KAMEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/06/2025
Certification Date: 06/26/2025
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 # A117
SAN LUIS OBISPO CA
93405-1615
US

V. Phone/Fax

Practice location:
  • Phone: 805-596-1565
  • Fax: 833-428-4062
Mailing address:
  • Phone: 55-961-5658
  • Fax: 833-428-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13673
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number240096
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA115526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: