Provider Demographics
NPI:1457309106
Name:IGAMA, JULIET RUIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIET
Middle Name:RUIZ
Last Name:IGAMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2715 COLONIAL DR STE 200B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6818
Mailing Address - Country:US
Mailing Address - Phone:803-397-5285
Mailing Address - Fax:803-898-4892
Practice Address - Street 1:2715 COLONIAL DR. SUITE 200B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6818
Practice Address - Country:US
Practice Address - Phone:803-397-5285
Practice Address - Fax:803-898-4892
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL243912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE34430Medicare UPIN