Healthcare Provider Details

I. General information

NPI: 1528015849
Provider Name (Legal Business Name): BRIAN PAUL MITU F.N.P., P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE STE 162
FOUNTAIN VALLEY CA
92708-7510
US

IV. Provider business mailing address

21515 HAWTHORNE BLVD STE 200
TORRANCE CA
90503-6512
US

V. Phone/Fax

Practice location:
  • Phone: 562-786-6723
  • Fax: 562-786-6956
Mailing address:
  • Phone: 562-786-6723
  • Fax: 562-786-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number18341
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16318
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number16318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: