Healthcare Provider Details

I. General information

NPI: 1194640631
Provider Name (Legal Business Name): RITA TALAR BADROSIAN MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 STATE UNIVERSITY DR
LOS ANGELES CA
90032-4226
US

IV. Provider business mailing address

12827 W HEMINGWAY DR
SAN FERNANDO CA
91340-1542
US

V. Phone/Fax

Practice location:
  • Phone: 323-343-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000060900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: