# SOUTHERN OREGON GYNECOLOGY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861293284
- **Authorized official:** LORETTA SANDOVAL NP, CNM (PROVIDER, OWNER)
- **Authorized official phone:** (541) 500-4747

## Contact information

- **Practice address:** 2850 STATE ST, MEDFORD, OR 97504-8474
- **Practice address phone:** (541) 500-4747
- **Practice address fax:** (866) 267-6644
- **Mailing address:** 2850 STATE ST, MEDFORD, OR 97504-8474
- **Mailing address phone:** (541) 500-4747
- **Mailing address fax:** (866) 267-6644

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | — | NULL | Yes |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/21/2025
- **Last updated:** 06/22/2026