MEDICARE: JERMAINE DASHAWN CALHOUN JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1336081926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERMAINE DASHAWN CALHOUN JR.

Provider Business Mailing Address
First Line	:	996 ROYAL MARCO WAY
Second Line	:
City	:	MARCO ISLAND
State	:	FL
Zip	:	34145-1829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12125 DAY ST
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-6702
Country	:	US
Telephone Number	:	469-694-1754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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