Healthcare Provider Details

I. General information

NPI: 1497956569
Provider Name (Legal Business Name): CARLOS A RICOTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 NE 87TH ST
MIAMI FL
33138
US

IV. Provider business mailing address

8700 W FLAGLER ST STE 100
MIAMI FL
33174-2535
US

V. Phone/Fax

Practice location:
  • Phone: 305-527-1884
  • Fax:
Mailing address:
  • Phone: 305-267-7979
  • Fax: 786-513-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME106515
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number2020-04673
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberN0402
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number59565
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME106515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: