MEDICARE: DR. JULIET RUIZ IGAMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	LL24391	SC

General Provider Information

NPI Number	:	1457309106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIET RUIZ IGAMA M.D.

Provider Business Mailing Address
First Line	:	2715 COLONIAL DR STE 200B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6818
Country	:	US
Telephone Number	:	803-397-5285
Fax Number	:	803-898-4892

Provider Business Practice Location Address
First Line	:	2715 COLONIAL DR. SUITE 200B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6818
Country	:	US
Telephone Number	:	803-397-5285
Fax Number	:	803-898-4892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	08/01/2013

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