Provider Demographics
NPI:1649065160
Name:GONZALEZ, ANTONIO JR (QBHS)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:GONZALEZ
Suffix:JR
Gender:
Credentials:QBHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7603 FIRST PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-6703
Mailing Address - Country:US
Mailing Address - Phone:216-317-2342
Mailing Address - Fax:
Practice Address - Street 1:7603 FIRST PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-6703
Practice Address - Country:US
Practice Address - Phone:216-317-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator