Provider Demographics
NPI:1225828635
Name:FANIKS HEALTHCARE PROFESSIONALS, LLC
Entity type:Organization
Organization Name:FANIKS HEALTHCARE PROFESSIONALS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:G
Authorized Official - Last Name:FANIKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-323-1280
Mailing Address - Street 1:9508 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7521
Mailing Address - Country:US
Mailing Address - Phone:800-323-1280
Mailing Address - Fax:
Practice Address - Street 1:9508 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7521
Practice Address - Country:US
Practice Address - Phone:510-282-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty