Individual
MRS. CARLY MARIE BASIRICO ERARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2295 S VINEYARD AVE, ONTARIO, CA 91761-7925
(909) 724-3083
Mailing address
2295 S VINEYARD AVE, ONTARIO, CA 91761-7925
(909) 724-3083
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA19878
CA
Other
Enumeration date
10/04/2008
Last updated
10/08/2021
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