Healthcare Provider Details

I. General information

NPI: 1497674717
Provider Name (Legal Business Name): SERGIO GARCIA JIMENEZ RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 W FRANKLIN RD APT A303
BOISE ID
83705-1057
US

IV. Provider business mailing address

5616 W FRANKLIN RD APT A303
BOISE ID
83705-1057
US

V. Phone/Fax

Practice location:
  • Phone: 208-647-2652
  • Fax:
Mailing address:
  • Phone: 208-647-2652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86414777
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: