=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336733203
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERITUS MEDICAL TECHNOLOGY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2021
-----------------------------------------------------
Last Update Date | 01/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 181 TECHNOLOGY DR STE 100
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-2485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-418-7225
-----------------------------------------------------
Fax | 949-418-7287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 181 TECHNOLOGY DR STE 100
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-2485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-418-7225
-----------------------------------------------------
Fax | 949-418-7287
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | ROBERT EMBREE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-418-7225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------