Healthcare Provider Details

I. General information

NPI: 1417653312
Provider Name (Legal Business Name): BIG DOG SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 WEST RD STE 135
LOS ALAMOS NM
87544-1776
US

IV. Provider business mailing address

51 ZUNI ST
LOS ALAMOS NM
87544-2647
US

V. Phone/Fax

Practice location:
  • Phone: 505-500-4301
  • Fax:
Mailing address:
  • Phone: 218-310-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SETH MICHAEL FELICE
Title or Position: OWNER DOCTOR
Credential: DPM
Phone: 505-500-4301