MARK GRANDA
NPI 1366374563
Counselor - Addiction (Substance Use Disorder) in San Antonio, TX
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 and is a graduate of Other (2025).
NPPES Registry Identity
Specialties & Licenses
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).
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mark Granda's NPI number?
The NPI number for Mark Granda is 1366374563. It was assigned to this individual provider in the NPPES registry on June 1, 2026.
Where is Mark Granda located?
Mark Granda practices at 12640 Corona Borealis, San Antonio, TX 78245. The listed phone number is (830) 225-1622.
What is Mark Granda's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.
Is Mark Granda enrolled in Medicare?
Yes. Mark Granda is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Mark Granda was last updated on June 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 54 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mark Granda · NPI 1366374563
Addiction (Substance Use Disorder) provider in San Antonio, Texas. Individual provider, active in the CMS NPPES registry since June 1, 2026.
## Identity
- **NPI:** 1366374563 (Entity type: Individual)
- **Enumerated:** June 1, 2026
- **Primary specialty:** Counselor - Addiction (Substance Use Disorder) · taxonomy 101YA0400X
- **State license:** 17557 (Texas)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 12640 CORONA BOREALIS, San Antonio, TX 78245-4861
- **Phone:** (830) 225-1622
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Medical school:** Other, class of 2025
## Record status
- **NPPES last updated:** June 29, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1366374563) · Data from the CMS NPPES public registry.