Provider Demographics
NPI:1437747003
Name:VELARDE, RESTITUTO
Entity Type:Individual
Prefix:
First Name:RESTITUTO
Middle Name:
Last Name:VELARDE
Suffix:
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 1:3973 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6887
Mailing Address - Country:US
Mailing Address - Phone:330-968-7455
Mailing Address - Fax:
Practice Address - Street 1:224 W EXCHANGE ST STE 330
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1715
Practice Address - Country:US
Practice Address - Phone:330-436-3150
Practice Address - Fax:330-436-3160
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0028319363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily