Individual provider Active NPI

Brian Manalansan Gutierrez, MD

  • Student in an Organized Health Care Education/Training Program
  • Staten Island, NY
National Provider Identifier
1972394781
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
355 Bard Avenue
Department of Medicine Villa BLDG 1St Floor
Staten Island, NY 10310
Phone
(718) 818-2419
NPI assigned
May 13, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

355 Bard Avenue
Department of Medicine Villa BLDG 1St Floor
Staten Island, NY 10310

Mailing address

355 Bard Avenue
Department of Medicine Villa BLDG 1St Floor
Staten Island, NY 10310
Phone (718) 818-2419

Other practice location 1

16600 Sherman Way Ste 178
Van Nuys, CA 91406-3875
Phone (818) 235-1414

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1972394781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 BARD AVENUE",
            "address_2": "DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10310",
            "telephone_number": "718-818-2419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVENUE",
            "address_2": "DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10310",
            "telephone_number": "718-818-2419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16600 Sherman Way Ste 178",
            "address_purpose": "LOCATION",
            "city": "Van Nuys",
            "state": "CA",
            "postal_code": "914063875",
            "country_code": "US",
            "telephone_number": "818-235-1414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "BRIAN",
        "middle_name": "MANALANSAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-13",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.