Ulises Ernesto Carballosa Fernandez

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30.028142 Issued in OH

Practice address

2203 Lake Ave
Ashtabula, OH 44004-3437

Phone

(440) 381-8800

NPI assigned

May 15, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1558051367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10803 LAKE AVE APT 104",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441021249",
            "telephone_number": "786-690-1609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2203 LAKE AVE",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440043437",
            "telephone_number": "440-381-8800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4071 Lee Rd Ste 260",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441282173",
            "country_code": "US",
            "telephone_number": "216-727-1164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARBALLOSA FERNANDEZ",
        "first_name": "ULISES",
        "middle_name": "ERNESTO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-15",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "RES.004578",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.028142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Reese Camplese
• Donna Lee Camplese I
• Morningstar Esperanza Cantu
• Brenda Merna Capp, RN REGISTERED NURSE
• Jamealyn Noelle Capuano
• Hollis Shea Carden
• Carington Park Nursing Home
• Andrew Thomas Carlin, PT, DPT
• Olivia Anne Carlson, BSW
• Jason Robert Carmody

• General Practice Dentistry in Ashtabula, OH
• Providers in Ashtabula, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.