MEDICARE: INNER MILESTONES CA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1952193666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER MILESTONES CA LLC

Provider Business Mailing Address
First Line	:	9025 ALCOTT ST APT 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-3375
Country	:	US
Telephone Number	:	347-693-9378
Fax Number	:

Provider Business Practice Location Address
First Line	:	9025 ALCOTT ST APT 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-3375
Country	:	US
Telephone Number	:	347-693-9378
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANGER
Name	:	MR. ELLIOT ELISHA GHANOONI
Credential	:
Telephone Number	:	347-693-9378

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	02/28/2026

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