Healthcare Provider Details

I. General information

NPI: 1104167758
Provider Name (Legal Business Name): ELIZA RIVERA-MITU PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
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 TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number23310
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number507599
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23310
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number23310
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number507599
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number23310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: