Healthcare Provider Details

I. General information

NPI: 1114853223
Provider Name (Legal Business Name): EMERITUS PROFESSIONAL MEDICAL CORPORATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 TECHNOLOGY DR STE 100A
IRVINE CA
92618-2484
US

IV. Provider business mailing address

181 TECHNOLOGY DR STE 100A
IRVINE CA
92618-2484
US

V. Phone/Fax

Practice location:
  • Phone: 949-418-7225
  • Fax: 949-418-7287
Mailing address:
  • Phone: 949-418-7225
  • Fax: 949-418-7287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON ALLCHIN
Title or Position: PRESIDENT
Credential:
Phone: 949-338-2594