Provider Demographics
NPI:1336028570
Name:GONZALEZ, MARCOS ANTONIO II
Entity type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:ANTONIO
Last Name:GONZALEZ
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 FROST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3126
Mailing Address - Country:US
Mailing Address - Phone:215-678-1322
Mailing Address - Fax:
Practice Address - Street 1:4218 FROST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3126
Practice Address - Country:US
Practice Address - Phone:215-678-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30910842106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician