Healthcare Provider Details

I. General information

NPI: 1265396311
Provider Name (Legal Business Name): OCTLC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 VESUVIUS DR
BREA CA
92823-6343
US

IV. Provider business mailing address

3943 IRVINE BLVD # 5
IRVINE CA
92602-2400
US

V. Phone/Fax

Practice location:
  • Phone: 818-636-2938
  • Fax: 833-930-2303
Mailing address:
  • Phone: 818-636-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SAYEH SEYEDFATHI
Title or Position: CEO
Credential:
Phone: 818-636-2938