MEDICARE: INNER MILESTONES CO 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	:	1316839194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER MILESTONES CO 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	:	612-368-9870
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	:	612-368-9870
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. ELLIOT GHANOONI
Credential	:
Telephone Number	:	612-368-9870

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	07/16/2025

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