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General NPI Number Information
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NPI Number | 1033043914
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Entity Type | Organization
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Legal Business Name | PRESTIGE PEAK MEDICAL
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Dates
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Enumeration Date | 06/09/2026
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 805 EAGLERIDGE BLVD STE 165
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City | PUEBLO
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State | CO
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Zip | 81008-2190
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Country | US
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Telephone | 719-205-0816
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Fax |
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Provider Business Mailing Address
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Address Line | 805 EAGLERIDGE BLVD STE 165
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City | PUEBLO
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State | CO
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Zip | 81008-2190
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Country | US
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Telephone | 719-205-0816
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ANGELA MARIE PERIDES
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Credential | NP
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Telephone | 719-877-1391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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