Basic Information
| Provider Information | |||||||||
| NPI: | 1831455781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROLO | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 453 QUARRY RD # 5327 | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504978000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 725 WELCH RD | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504978000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2012 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 20783 | NV | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD60928831 | WA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | A126464 | CA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1831455781 | 05 | WA | MEDICAID |