Karl Udalve Tabora
Individual provider Active NPI Family Nurse Practitioner · Needles, CA
NPI 1225826720 · NPPES record last updated Jun 27, 2025
Key facts
- NPI
- 1225826720
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 95034737 (CA)
- Practice address
- 1401 Bailey Ave
Needles, CA 92363-3103 - Phone
- (916) 831-0782
- NPI assigned
- Apr 25, 2025
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tri-State Medical Specialists LLC
Practice addresses (Care Compare)
1510 E Wagon Wheel LN
Suite 110
Fort Mohave, AZ 86426-6698
Phone (928) 788-3333
Hospital & facility affiliations
- Valley View Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250825001811 | AZ | Practitioner - Nurse Practitioner | 9931609880 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95034737 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-State Medical Specialists LLC | Current |
Accepting new patients | |
| Tri-State Medical Specialists LLC | Family | Current |
Accepting new patients |
Locations
1510 E Wagon Wheel Ln
Ste 110
Fort Mohave, AZ 86426
Phone (904) 994-5560
1401 Bailey Ave
Needles, CA 92363
Phone (760) 326-4531
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95034737 | CA | Yes |
Addresses
Primary practice location
1401 Bailey Ave
Needles, CA 92363-3103
Mailing address
1510 E Wagon Wheel LN Ste 104
Fort Mohave, AZ 86426-6698
Phone (928) 889-2273
Other providers in Needles, CA
- Adele Rozsa
- David C Rubio
- Carl A Russell
- Stacia Shaver
- Alia Ali Smith
- Knaya Corazon Tabora I
- Thrifty Payless Inc
- Tri-State Community Healthcare Center
- Tri-State Community Healthcare Center
- Tri-State Vascular Group, PLLC
All providers in Needles, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.