MEDICARE: ABUNDANTLY FRUITFUL

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1528855194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANTLY FRUITFUL

Provider Business Mailing Address
First Line	:	1621 CENTRAL AVE STE 8525
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 CENTRAL AVE STE 8525
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4531
Country	:	US
Telephone Number	:	626-716-7390
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LA VALLE FOSTER
Credential	:
Telephone Number	:	626-716-7390

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	04/24/2025

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Directions to “ABUNDANTLY FRUITFUL ” Practice Location

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