Organization
BACCHUS, MOGHADDAM, MUSNGI, SHWAYDER MEDICAL CORP.
Active
Other names
Calming Goat Addiction Medicine Group
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SOROYA BACCHUS MD (COO)
(310) 901-6262
Entity
Organization
Contact information
Practice address
6801 PARK TER # 530B, LOS ANGELES, CA 90045-1543
(424) 376-3444
(424) 298-4156
Mailing address
PO BOX 1085, TORRANCE, CA 90505-0085
(888) 448-4628
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0015X
Psychosomatic Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G74246
MEDICAL LICENSE
CA
Enumeration date
03/06/2019
Last updated
07/29/2020
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