Organization
DIANE TACKIE GRANILLO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE TACKIE GRANILLO PA-C (OWNER)
(202) 951-7942
Entity
Organization
Contact information
Practice address
1395 PICCARD DR STE 200, ROCKVILLE, MD 20850-4348
(202) 951-7942
(202) 971-1991
Mailing address
1395 PICCARD DR STE 200, ROCKVILLE, MD 20850-4348
(202) 951-7942
(202) 971-1991
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
05/09/2025
Last updated
03/19/2026
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