Healthcare Provider Details

I. General information

NPI: 1942978960
Provider Name (Legal Business Name): PICNICCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CLAY ST STE 600B
OAKLAND CA
94612-1425
US

IV. Provider business mailing address

1300 CLAY ST STE 600B
OAKLAND CA
94612-1425
US

V. Phone/Fax

Practice location:
  • Phone: 415-723-2170
  • Fax:
Mailing address:
  • Phone: 415-801-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHET THARPE
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 415-723-2170