Healthcare Provider Details

I. General information

NPI: 1225828635
Provider Name (Legal Business Name): FANIKS HEALTHCARE PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9508 VIRGINIA AVE
LUBBOCK TX
79424-7521
US

IV. Provider business mailing address

9508 VIRGINIA AVE
LUBBOCK TX
79424-7521
US

V. Phone/Fax

Practice location:
  • Phone: 510-282-0933
  • Fax:
Mailing address:
  • Phone: 832-741-0534
  • Fax: 806-255-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREW G. FANIKU
Title or Position: MANAGER
Credential: MD
Phone: 832-741-0534