Odyzza Jane Centro, PA-C
Physician Assistant in Fairfax, VA. Individual provider (NPI-1).
NPI number1104583947
StatusActive
Last updated in NPPESMar 9, 2023
Details
- NPI
- 1104583947
- Entity type
- Individual (NPI-1)
- Name
- Odyzza Jane Centro
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 28, 2021
- Certification date
- Mar 9, 2023
- Last updated
- Mar 9, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 0110008245 | VA | Yes |
| 363A00000X | Physician Assistant | C0008268 | MD |
Practice location
8081 Innovation Park Dr Ste 500Fairfax, VA 22031-4867
Phone 571-472-7040 · Fax 571-472-7041
Mailing address
121 Congressional Ln Ste 409Rockville, MD 20852-1542
Phone 301-881-0230
Other practice locations
121 Congressional Ln Ste 409
Rockville, MD 20852-1542
Rockville, MD 20852-1542
Phone 301-881-0230
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