MEDICARE: SOUTHERN OREGON GYNECOLOGY LLC

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner

General Provider Information

NPI Number	:	1861293284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN OREGON GYNECOLOGY LLC

Provider Business Mailing Address
First Line	:	2850 STATE ST
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-8474
Country	:	US
Telephone Number	:	541-500-4747
Fax Number	:	866-267-6644

Provider Business Practice Location Address
First Line	:	2850 STATE ST
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-8474
Country	:	US
Telephone Number	:	541-500-4747
Fax Number	:	866-267-6644

Authorized Official
Title or Position	:	PROVIDER, OWNER
Name	:	LORETTA SANDOVAL
Credential	:	NP, CNM
Telephone Number	:	541-500-4747

Provider Enumeration Date	:	03/21/2025
Last Update Date	:	06/22/2026

Similar Medicare Providers

1306182431 — KAREN ROACH RN
Practice Location Address:

2860 STATE ST
MEDFORD, OR
97504-8474

Practice Phone: 541-776-6222
Practice Fax: 541-776-6215

1023461019 — JULIANNE BALTZLEY
Practice Location Address:

2409 SE 149TH AVENUE
PORTLAND, OR
97233

Practice Phone: 971-302-6256
Practice Fax: 971-302-6257

1508337858 — SAMANTHA CHMURA OTR
Practice Location Address:

120 MURRAY ST
MEDFORD, MA
02155-1300

Practice Phone: 603-966-8474
Practice Fax:

1700882610 — DR. NORMA BILBOOL MD
Practice Location Address:

222 ROUTE 59 , SUITE 106
SUFFERN, NY
10901-5204

Practice Phone: 800-750-8616
Practice Fax: 845-362-8474

1891791570 — DR. RAJINDER PARMAR MD
Practice Location Address:

1070 WILDWOOD CENTRE DR
COLUMBIA, SC
29229-8420

Practice Phone: 803-260-0006
Practice Fax: 803-753-8474

1124015995 — VILLAGE OF ST BERNARD
Practice Location Address:

4200 VINE ST
SAINT BERNARD, OH
45217-1529

Practice Phone: 513-242-8474
Practice Fax: 513-242-0305

Directions to “SOUTHERN OREGON GYNECOLOGY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.