Healthcare Provider Details

I. General information

NPI: 1033933007
Provider Name (Legal Business Name): BRENA LYNN FIORILLO REIKI MASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 SE MILWAUKIE AVE STE F
PORTLAND OR
97202-3835
US

IV. Provider business mailing address

3828 N KILPATRICK ST
PORTLAND OR
97217-7244
US

V. Phone/Fax

Practice location:
  • Phone: 503-841-5323
  • Fax: 503-525-2516
Mailing address:
  • Phone: 206-914-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: