Healthcare Provider Details

I. General information

NPI: 1508747957
Provider Name (Legal Business Name): RAKI MARINA 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10526 MARINA WAY
BOCA RATON FL
33428-5713
US

IV. Provider business mailing address

10526 MARINA WAY
BOCA RATON FL
33428-5713
US

V. Phone/Fax

Practice location:
  • Phone: 617-340-8693
  • Fax: 781-658-2096
Mailing address:
  • Phone: 617-340-8693
  • Fax: 781-658-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. VALENTINA AKYOL
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 781-535-4386