Russell Fornator, CCP
Specialist in Phoenix, AZ. Individual provider (NPI-1).
NPI number1033247481
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1033247481
- Entity type
- Individual (NPI-1)
- Name
- Russell Fornator
- Credential
- CCP
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 28, 2007
- Last updated
- Jul 8, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | – | – | Yes |
Practice location
10930 N Tatum Blvd#103
Phoenix, AZ 85028-6069
Phone 602-263-7600 · Fax 602-212-0365
Mailing address
10930 N Tatum Blvd#103
Phoenix, AZ 85028-6069
Phone 602-263-7600 · Fax 602-212-0365
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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