Provider Demographics
NPI:1811342355
Name:GINNARD, OLIVIA ZOFIA BENTKOWSKI (DO)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ZOFIA BENTKOWSKI
Last Name:GINNARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:ZOFIA
Other - Last Name:BENTKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6621 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2399
Mailing Address - Country:US
Mailing Address - Phone:832-822-3780
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2358
Practice Address - Country:US
Practice Address - Phone:832-822-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10056543208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics