Provider Demographics
NPI:1356149827
Name:GONZALEZ, MARLON C (OWNER)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:OWNER
Other - Prefix:
Other - First Name:MARLON
Other - Middle Name:CHRIST
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OWNER
Mailing Address - Street 1:202 W SCHUNIOR ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-3142
Mailing Address - Country:US
Mailing Address - Phone:956-929-6042
Mailing Address - Fax:
Practice Address - Street 1:202 W SHUNIOR ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542
Practice Address - Country:US
Practice Address - Phone:956-929-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3720261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care