Provider Demographics
NPI:1629939467
Name:HEMMINGER, AUDREY ARIAS
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:ARIAS
Last Name:HEMMINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AUGUSTO
Other - Middle Name:ARIAS
Other - Last Name:HEMMINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1502 ALICE ST APT 20
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-4188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19600 CULL CANYON RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-3715
Practice Address - Country:US
Practice Address - Phone:510-538-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC92350612C171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach