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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

MARK GRANDA
NPI 1366374563
Counselor - Addiction (Substance Use Disorder) in San Antonio, TX

Active since June 01, 2026PECOS Enrolled
12640 CORONA BOREALIS, SAN ANTONIO, TX 78245(830) 225-1622 Get Directions Write a Review

NPPES record last updated: June 29, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Mark Granda NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK GRANDA (NPI 1366374563) is an individual addiction (substance use disorder) provider in San Antonio, Texas, licensed in Texas (17557) and active in the NPI registry since June 2026. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1366374563
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameMARK GRANDA
Location Address12640 CORONA BOREALISSan Antonio, TX 78245-4861
Mailing Address12640 Corona BorealisSan Antonio, TX 78245-4861 · (830) 225-1622
Phone(830) 225-1622
Sole ProprietorYes
Enumeration DateJune 1, 2026
Last NPPES UpdateJune 29, 2026
NPPES CertifiedJune 29, 2026
✔ NPI 1366374563 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in TX · 17557
12640 CORONA BOREALIS, San Antonio, TX 78245
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mark Granda is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions

What is Mark Granda's NPI number?

The NPI number assigned to this healthcare provider is 1366374563, enumerated as an "individual" on June 01, 2026.

Where is the provider located?

The provider is located at 12640 CORONA BOREALIS SAN ANTONIO, TX 78245 and the phone number is (830) 225-1622.

What is the provider's specialty?

Counselor with taxonomy code 101YA0400X and a focus in Addiction (Substance Use Disorder).