Individual
REILLY JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2235 12TH ST APT B117, IDAHO FALLS, ID 83404-5721
(208) 419-1319
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6501
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
07/31/2023
Last updated
10/01/2025
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